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Abstract

The social forces that influence patient portal use behavior among the elderly are not well understood. Using both institutional theory and the Unified Theory of Acceptance and Use of Technology, the proposed model examines three social environmental factors ? normative, mimetic, and coercive forces ? within a Health Information Technology (HIT) context. An empirical study involving 117 subjects in the United States was used to test the proposed model. Using the partial least squares method, mimetic and coercive pressures were found to significantly influence patient portal use behavior. These findings indicate that older people follow not only their providers' advice, but also follow the behavior of respected, higher-status peers from their network. Normative pressure was not found to be significant, implying that older people do not follow the bandwagon effect.

The use of electronic health records (EHR) is also on the rise. A 2014 study (Hsiao & Hing, 2014) shows that about 80% of office-based physicians in the US use EHRs, and a majority of them (69%) are committed to participate in the meaningful use incentive payment program available in the United States (Blumenthal & Tavenner, 2010). One of the Stage 2 Core Set objectives to achieve meaningful is “provide patients the ability to view online, download, and transmit their health information” (HealthIT.gov). This means that healthcare providers with EHR systems are mandated to provide patients with access to personal health information over the Internet using a secure online portal. Several other countries are introducing similar initiatives as they try to both improve health outcomes and strive for efficiencies in their health systems (Wickramasinghe, Davey, & Tatnall, 2013).

Numerous studies examine patient portal acceptance and use (Goldzweig et al., 2013; Ancker et al., 2011; Smith et al., 2015; Sarkar et al., 2011; Goel et al., 2011; Jung et al., 2011; Weppner et al., 2010). Patients with chronic conditions are more likely to accept and use patient portals (Goldzweig et al., 2013; Ancker et al., 2011; Millard & Fintak, 2002). Patient age is negatively correlated with portal adoption and use, especially among older patients (Goel et al., 2011; Jung, Padman, Shevchik, et al., 2011; Weppner et al., 2010). Roughly 20% of the US population will be over the age of 65 by 2030 in the next decade due to longer life spans and aging baby boomers (CDC, 2013), and it has been established that doctor visits and medical spending increase during the final years of life (Hogan, Lunney, Gabel, & Lynn, 2001). In fact, some studies indicate a quarter of an individual’s medical spending occurs in their final year (Lubitz & Riley, 1993). Hence, one can conclude that while older patients could benefit most from patient portals, they are the least likely group to use them.

Key Terms in this Chapter

Health IT Adoption: Healthcare information technology (Health IT) is the use of computer applications to record, store, protect, retrieve, and transfer clinical, administrative, and financial information electronically within and among various health care settings. ( www.hrsa.org ). Adoption of Health IT for the purposes of this research is defined as the process from being aware of the technology to the effective and efficient usage for the intended purpose.

Institutional Theory: In this paper, Institutional Theory is defined as the guidelines for social behavior in the form of accepted structures, schemas, rules, norms, and routines influenced by other members of the collective network of actors.

Health IT Usage: Accessing personal health information by the intended recipient through electronic medium and application designed for informational or decision making reason purpose.